Closing the Opportunity Gap for Young Children (2023) / Chapter Skim
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or less, compared with almost half of White children. In a study of BLL and third-grade test scores, non-Hispanic Black students had a mean BLL of 7.7 μg/dL -- more than twice that of non-Hispanic White students (3.7 μg/dL; Evens et al., 2015; National Center for Healthy Housing, 2013)
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Therefore, these contaminants may have both immediate impacts on health and wellness and long-term effects on chronic disease, educational attainment and achievement, and mortality. Opportunity gaps related to environmental contaminants As the evidence reported above demonstrates, children experience differing levels of exposure to environmental contaminants, such as lead and those that place them at risk of asthma.
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. Proximity to sources of pollutants is in turn determined by other, more upstream risk factors, most notably family poverty, neighborhood poverty and disadvantage, and residential segregation driven by structural racism in housing policies, discussed in turn below.
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of victims are aged 0–2 years. Among school-based children, African American students, students who qualify for free/reduced-price lunch (i.e., those from families with low incomes)
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. Aside from problems with cognitive performance, seriously injured young people may also experience psychological and physical health problems that can adversely affect their academic performance (Foster et al., 2019a,b)
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Opportunity gaps related to safety and exposure to violence Several factors may explain the above disparities in young children's exposure to violence; they include individual, family, and place-based risk factors. On an individual level, babies under 1 year old experience higher rates of injuries and maltreatment (CDC, 2014, 2021)
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Black children and teens are four times more likely than their White peers to die from gun violence. FIGURE 4-1 Leading causes of death among children and adolescents in the United States, 1999–2020.
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. ADDRESSING OPPORTUNITY GAPS IN PHYSICAL HEALTH AND HEALTH CARE Opportunity gaps in the physical health and health care of young children can be addressed through efforts focused on poverty reduction, access to pediatric and family health care, antiracism and dismantling of race-based medicine, screening for social influences on health, alternative models for delivering health care, and safe and violence-free environments.
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Among those federal governmental programs specifically designed to address poverty are the earned income tax credit, the child tax credit, and the Supplemental Nutrition Assistance Program, which provide cash or inkind transfers to low-income families, and all of which have been shown to reduce poverty and improve child health outcomes. The temporary expansion of the child tax credit in response to the COVID-19 pandemic had a significant impact on poverty alleviation, reducing child poverty by about 30% and decreasing food insufficiency, with implications for the well-being of many of the nation's most vulnerable children.
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Race-based medicine is a clear driver of opportunity gaps in medical treatment and care. Antiracism is an active practice that involves learning about how racism is constructed, operationalized, and perpetuated and working to dismantle those systems.
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There remains a critical need for research comparing models for delivering primary care and examining their impact on racial/ethnic and socioeconomic inequities in preventive care utilization and health outcomes. Safe and Violence-free Environments Given the numerous risk factors that place children at higher risk of exposure to unsafe environments, individual and family interventions are unlikely to be sufficient; multilevel societal interventions and policies are needed.
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In all of these cases, however, notable disparities exist by race/ethnicity, income, rural versus urban residence, and immigration status. In the prenatal period, adverse outcomes experienced by children and birthing people are often due to preventable pregnancy and birth complications, inadequate access to health insurance, and suboptimal prenatal care.
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Children of color and those from lower-income households are more likely to experience these opportunity gaps. The COVID-19 pandemic and related policies, such as school closures, exacerbated these disparities, because of both the disproportionate burden of disease experienced by low-income communities and people of color and the further limitations placed on access to key material and psychosocial resources among marginalized groups.
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. The child opportunity gap: Inequities in child opportunity within metros.
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. Income disparities in the association of the medical home with child health.
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. Cognitive and behavioral outcomes of school-aged children who were born preterm: A meta-analysis.
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. Unconventional natural gas development and birth outcomes in Pennsylvania, USA.
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. Well-child care clinical practice redesign for young children: A systematic review of strategies and tools.
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. Socioeconomic and racial disparities in parental perception and experience of having a medical home, 2007 to 2011–2012.
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. A randomized con trolled trial of group well-child care: Improved attendance and vaccination timeliness.
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. From medical home to health neighborhood: Transforming the medical home into a community-based health neighborhood.
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. Poverty and child development: A longitudinal study of the impact of the earned income tax credit.
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. Feasibil ity and acceptability in a community-partnered implementation of CenteringParenting for group well-child care.
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. Effect of the Earned Income Tax Credit on hospital admissions for pediatric abusive head trauma, 1995–2013.
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. Association of state-level earned income tax credits with rates of reported child maltreatment, 2004–2017.
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National Vital Statistics Reports, 68(13)
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. NAPNAP position statement on pediatric health care/medical home: Key issues on delivery, reimbursement, and leader ship.
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. Update on the feasibility, acceptability, and impact of group well-child care.
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. COVID-19 and the decline of well-child care: Implica tions for children, families, and states.
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. Race/ethnicity in medical education: An analysis of a question bank for step 1 of the United States medical licensing examination.
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. Group well-child care for high-risk families: Maternal outcomes.
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. Health care utilization and health status in high-risk children randomized to receive group or individual well child care.
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. Perinatal and maternal risk factors for autism spectrum disorders in New South Wales, Aus tralia.
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5 Opportunity Gaps in the Social Emotional Development, Well being, and Mental Health Experienced by Young Children Opportunity gaps in social-emotional development, well-being, and mental health result from numerous factors experienced both by children and their parents or other caregivers. The committee begins its discussion of these gaps by showing that the path to mental health and well-being in adolescence and adulthood starts at birth (Institute of Medicine & National Research Council [IOM & NRC]
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. Finally, the chapter identifies policies and practices that affect family functioning and mental health and well-being in the first several years of life as potential targets for efforts to eliminate opportunity gaps in social-emotional development, well-being, and mental health.
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. Scientific findings on child development over the past several decades have shown what kinds of environmental experiences are essential for optimal cognitive, social-emotional, and behavioral development.
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. HOW DISPARITIES IN CHILD OUTCOMES DEVELOP The same studies that identify the environmental opportunities that enable young children to learn and grow also provide the basis for understanding that if there are disparities in these opportunities across groups based on income, race, ethnicity, or geography, disparities in outcomes for children will result (McLoyd, Hill, & Dodge, 2005)
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Disparities and Opportunity Gaps in Mental Health in Early Childhood The mental health of young children is critical for their academic outcomes and general health and well-being (Mashburn et al., 2008)
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Moreover, mental health disparities related to socioeconomic status were more apparent in younger than in older children (Jones Harden & Slopen, 2022)
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As the preceding section of this chapter suggests, young children's mental health is grounded in individual, familial, and neighborhood processes, including sensitive and responsive caregiving, safe and stable home and neighborhood environments, and opportunities for supports outside the home. However, young children from families with low socioeconomic status and certain racial/ethnic backgrounds are deprived of many of these individual and environmental resources, a disparity that creates a large opportunity gap between them and children from less marginalized groups.
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. Children may also experience myriad systemic opportunity gaps, such as institutional factors -- including experiences in ECE and school, parental job quality and stability, neighborhood resources, and access to health care -- that affect children from impoverished and minoritized backgrounds (Yoshikawa, Aber, & Beardslee, 2012; Alegría et al., 2015)
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, creating an opportunity gap with respect to the mental health of young children in the early education arena. Parental job quality and stability are compromised for parents from low-income backgrounds and minoritized racial/ethnic groups.
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